Transulnar Aproach for PCI after failed ipilateral TRA: 2 sheaths in same arm, is it safe?

Abstract Aims To assess the feasibility and safety of transulnar access (TUA) after failure to cross through ipsilateral radial access (TRA), with two sheaths placed in same arm (RA and UA). Methods and results All consecutive patients, with TUA due to inability to cross from ipsilateral TRA in the period from March 2011 until December 2017 were included in the study. Pre-procedural wrist artery angiography was performed in all patients through radial and afterwards ipsilateral ulnar artery. We examined clinical and procedure characteristics, access site complications and cause of failure of primary chosen TRA. Patients were followed up with a median of 4 years. From March 2011 untill December 2017, 104 patients had a transulnar artery approach due to inability to cross from ipsilateral radial approach. Mean age of patients was 64±11 years with 48% females. 15% of patients had a PPCI intervention due to STEMI. Cause for crossover to ipsilateral TUA was due to: inability to cross an RA anomaly in 94 patients, inability to cross high degree RA spasm in 8 and in 2 patients due to dissection of the RA. Most common anomaly of the RA that caused inability to cross was full 360 degree RA loop in 53 (56%) patients. 49 Patients (47%) underwent percutaneous coronary intervention, 5 (4,8%) patients carotid artery stenting and 50 (48%) diagnostic coronary angiography through ipsilateral TUA. Procedure duration was 35±16 minutes, contrast volume 120±35 ml and fluoroscopy time was 8±6 minutes. Access site bleeding complications were present in 7 (6.7%) patients after procedure with Type 4 EASY Score hemathoma present in 3 patients (2.8%) without further consequences. 5.7% of patients had ipsilateral RAO noted on duplex on follow up. There were no ischemic hand complications after intervention and follow up with median of 4 years. Conclusion Transulnar artery access due to failed ipsilateral radial access crossing is safe and feasible for angiography and PCI with low rate of complications on long term follow up. TUA after failed TRA (2 sheaths) Funding Acknowledgement Type of funding source: None